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Because even when faced with others who firmly believe that they are doing the best they can, I still choose to advocate for women.

ACOG’s ethics statement offers us the idea that obstetricians are supposed to give women informed decision making and not force them, not coerce them, but let them actively participate in their care.

And yet, when a mother wants support for her birth, a trial of labor, even, we are supposed to believe that fears of malpractice within those facilities, or biased policies are supposed to trump her right to at least try to have a healthy labor and birth. Ethically, we are supposed to be bound to do no harm and yet, that premise has died a swift death in the face of a pretense for evidence-based care. Evidence-based care doesn’t mean there has to be specific evidence that every case will be perfect or that every case will be without risk. It means that we also have an ethical liability to not do procedures on women without evidence that it’s the best practice. We keep missing this part of the puzzle because it doesn’t fit our protocols. It can’t be fit within the parameters of a malpractice insurance document. It requires NOT acting unless there is a NEED to act. It requires prevention pf risk through being patient and awaiting a reason to act. And ultimately, it requires asking for permission to act from the woman herself, not telling her what she HAS to do, how NO providers will do it, and telling her that she should simply lie down for another surgery because it’s too risky to her providers.

I look at some photos of births and pregnancy and I think “wow, that is beautiful art caught in motion” but I don’t look at it like it’s REAL. It’s a moment of art caught by a photographer who is specifically looking to catch a moment in time that will then be transcendent. Birth IS beautiful but the reality is…reality. There is body, there are fluids, there is a baby entering the world, a mom working hard, people supporting her if not physically, then emotionally, spiritually, completely involved in her journey and their own. A life is pouring through into the world via intense powerful effort. Birth isn’t about that perfect photo. It’s about all the moments, together, as one, in a working form in all it’s ugly beautiful working sweating glory victory defeat surrender submission conquering action.

Being a teen mom makes you realize that stays with you for life. There is not a single story that mentions Loretta Lynn without mentioning her having her children as a young teenager. The thing is…what if we become who we are not in spite of having children young, but because of it? She sang to her siblings, she sang to her children and that led to her becoming a star. If she had never married young and sang to her children, she might well have lived in KY her entire life, undiscovered.

My children made me who I am, not because I didn’t make mistakes, do things young or act stupid, but because every time I did, I had to look at them and LEARN to be someone different. They are still working on me, I’m not a finished product.

Death is the one thing we simply don’t want to face. We fear the quiet, long goodbye, the misery of a life that is stretched out without alleviation from pain. We fear. We fear. We fear.
And therefore, we don’t do it well.
Mourn. Reach out. Have faith. Trust. And treat those who have had losses well, listen to them, even if you feel that you know better than them. This also extends to not using them for your own agendas or purposes. They have a right to believe in humanity as something that just listens to their loss and accepts it and helps them to be in that space of loss.

This graph shows what happens when a hospital is part of a pilot program to reduce non-medically indicated births. Notice, this isn’t a program that is designed to do anything other than stop NON MEDICALLY INDICATED births. The March of Dimes piloted this program due to the exponential rise in using non-medicine to control birth in order to fit it into nice, neat practice management patches with fewer lawsuits. This rise didn’t reflect safety for mothers or babies, in fact, it did the opposite, it endangered them.

http://health.usf.edu/publichealth/chiles/fpqc/past_projects.htm

So why isn’t it enough? Why is it a red herring?

Because ACOG has now renamed all of the “term” pregnancies that used to be 37-42 weeks in order to help “reduce” pre-39 week nonsensical obstetrical procedures but does NOTHING for all of the non-medically indicated procedures after 39 weeks, zero days. In effect, we are still forcing thousands, if not millions over time, of mothers and babies to undergo procedures they do not need and often do not want. And now, we’re forcing hospitals and doctors to not do it before 39 weeks so they are reloading their case load to meet moms and babies at 39.1 and 40 and still with no medical need. This may mean that babies come off better but we’re still increasing both morbidity and mortality well above normal.

There is another casualty in this ACOG redefinition as well. That of the Non-Bell Curve mother. If you go past 41.0, you are now in some imaginary place called “late term” and 42.0 is “post term”. These numbers and dates are going to move across obstetrical systems such as homebirth midwifery where they have no place being. Where now, midwifery laws have used “42” as if it’s some arbitrary cut-off wherein moms and babies become dangerous, who knows where ACOG and other hospital-based obstetrical groups or legislative groups will try to push those lines.

Late term: 41 0/7 weeks through 41 6/7 weeks

Postterm: 42 0/7 weeks and beyond

Ultimately, all of these concerns are played out on mothers but they are not considered when decisions are made. Safety of mothers and babies are not the overriding concerns of these kinds of recommendations that are given the force of law and regulations. Individual accountability, informed decision-making, none of these come up as the rights of mothers and babies are stripped away based on a professional organization’s opinion pieces.

Over the last few years, I keep using the term “normal, low-risk VBAC” and I’ve found others have begun to use it as well. After all, isn’t less than 1% of a risk really a LOW risk of it? Especially if the actual risk of death or severe complication is even lower?

Evidently, It’s all in the eye of the beholder.

When I did searches for ACOG and defining what “high risk” means, there really isn’t any true definition. It’s like there is an imaginary line wherein doctors get the heebie jeebies and they call any risk a “high” risk. So where is this cut-off and why is this word so prevalent in our society when it comes to medical care?

So, according to this definition, ANY risk above average risk is suddenly “high” risk and average or normal risk isn’t readily defined.

And this is how having twins comes to be called “high risk” when some might be absolutely normal risk for having twins and others might be of a slightly higher risk or a much higher risk for certain conditions. So how do we know what is normal risk, what is average risk, what is high risk? I’ll be exploring this through the next few posts.

Right now, many women are at high risk for having a cesarean just by virtue of walking in their local hospital. Normal women having healthy pregnancies have a 1/5 chance of having a cesarean without any further rise in complications during birth. So, all women are now at high risk? Are their doctors telling them?

There will be more on this over this week because I really want to explore this topic but we need to start holding doctors and nurses accountable to their language.

There is no “high risk” there is only risk. And my risk is either a relative risk or an absolute risk and you really only have a guess as to what my risk might be.

If we spent more time explaining to women that really, we don’t know what their risk IS even though we have an idea of what it MIGHT be in pretty rigid circumstances, then perhaps women would start understanding their care better.

Unfortunately, we’ve created a society where once you’ve told a woman she is high risk, she immediately agrees to whatever the doctors/nurses/hospitals say because she’s convinced that she and her baby are in very real danger of something that is very large and immediate.

This chart of ACOG’s helps outline exactly why they use terms like “high risk” in order to get women to consent to care rather than giving them choices and explaining individual risk. Are any of these procedures advisable? Recommended? Safe? Most individuals won’t feel it matters because they are told they are at “high risk” and it needs to be done. It’s horribly sloppy critical thinking on the part of the public, even if they WOULD choose these particular procedures, etc. And it’s intellectual laziness on the part of medical care to not allow individuals actual informed decision-making.

I’ve done it. We’ve all done it. We’ve read the story online about some mother that we know had a completely unnecessary cesarean. Just reading the story, as some doctor forced her body to open, stretching her cervix or inducing for dates and not indication, as the vbac “fails”, we cringe. We wonder how she didn’t see the signs. We can’t help but think about the story, we can’t help but be angry for her, hurt for her, sad for her. Why is this happening to her? How we do we stop it as a society if we can’t help one another be supported? How do we protect ourselves and our daughters, from this insanity?
These emotions flood us.
So what I’m about to say is important.
SHUT UP.
Not long-term, not forever. You don’t have to stop warning women, stop talking to them, not using your voice as much as you can.
But in this moment. With this mom.
This postpartum, just had a baby, mom.
She is not in that space. She is not processing the bigger picture.
She is in her own place, needing empathy, hope, and lots of loving on her and her baby.
She needs to recover from surgery, she needs to meet her newborn and learn to know them, she needs to take some time as she wraps her head around what has happened to her.
I did this not long ago. I had to stop, apologize and get out of the conversation because I had wronged the mother involved. She should NEVER have had to deal with my angry outburst towards her doctor at 3-4 days out.

What I should have done was this:
-Congratulate her on her baby
-Told her how cute her baby was
-Told her I wished her recovery and peace and healing
-Reminded her that when she was ready to process her experience or ask questions, whether it was in 2 weeks or 2 years, I am here for her to listen to her and help her walk that path.
-When she chooses to talk, ask questions and listen and help her come to her own answers, not provide them for her but holding her accountable to her own journey.

Remember
-To every thing there is a season, and a time to every purpose under heaven-

“Once a Cesarean, Always a Cesarean” never rings more true than when referring to a child’s birth. Even though a mother may later go on to have a vaginal birth or future healthy pregnancies, there is no way to step back into our footsteps in the snow and change that day in surgery. Sometimes, coping lasts a lifetime but there are critical moments in recovery in the first year that moms have to weave through and often, they are alone and unsupported. Most of the time, those close to them don’t even realize the impact of their words or actions, thinking they are sharing the moments with the new mother. On baby’s first birthday, many well-intentioned friends and family fail to see what is in front of them: a mother in mourning being forced into celebration.

A mom may ask herself if she’s even normal, because she feels so despondent or unwilling to plan birthday parties. She may throw herself into planning the biggest celebration possible, hoping it will drown all the pain out. The reality is, she often sees this is as the first anniversary of trauma. While not all cesarean moms view it this way, it’s important to understand how a mom could wind up in this emotional dilemma of baby’s birth vs mother’s birth experience.

Research shows that women remember their birth experiences for the rest of their lives. These stories impact not just today but the rest of their lives. A mother goes into labor and gives birth, remembering much of it while wrapped in the heightened sensations of labor. She remembers specific smells, looks, people’s faces and attitudes and words. As she goes into labor or is induced, she is often afraid of the unknown or even the known if this is not her first labor. She walks into the hospital and deals with strangers she is forced to trust at the most vulnerable time of her life. In some cases, she doesn’t really like her care provider or her nurses. Then, as labor continues, something changes and she labors longer and harder and suddenly, a cesarean. This isn’t what she prepared for, this is surgery. She is drugged, she is strapped down, and she is often throwing up. Sometimes, she is not even conscious, depending on the circumstances. Unable to help herself, she watches the ceiling as her body is cut open and her baby is taken away. Often, the obstetricians and nurses discuss their day or other clients or even football games. This event that was hers and personal becomes distracted and impersonal. Her baby is born and she gets a glimpse before having the baby removed, wrapped, and only a face and then gone to the nursery. There is no physical contact to solidify this bond between mother and child. There is no orgasm of love and completion in each other’s arms that is so tactile and important for every being. She is left alone with the staff, cleaned up and moved to recovery.

At this point, her husband or partner goes with the baby. They share joy, “Look at his hair! His fingers, his toes!” They call family and tell of joy in the new little person. His size, his weight, his features. They take cell phone pictures and post on Facebook or blogs. They are building a vision of love.

A year later, they share this vision. They talk over and over about the day he was born or the first moments they saw her. They are overwhelmed by the joy of that moment and they relish in it. “I was the first person to hold her!” a grandmother remembers. As they share these moments, the mother remembers, “Everyone held her but me. And when I finally got to hold her, it hurt so badly, I could barely move. “ They pass around pictures of baby’s first few moments, none of which include the mom except one, with an upside down baby’s face, wrapped tightly in a blanket, next to her head while she feebly smiles. She thinks to herself that even in that moment, she didn’t get to hold her baby or touch, skin to skin and feel the baby newness.

This is the reality of the first birthday. These flashbacks and moments where only the mother , and she alone, remembers and recovers her own experience. So how can someone help a mother in this situation? How can you, help yourself? Here are some tips on recovering at that first birthday:

Listen.

The new mother needs you to hear her side of the story.

Talk.

If you are the new mom, talk about the birth. Find someone you can share this with and just talk. Many women turn to online support at this time just to be able to get it out and share with other moms who get it.

Accept.

It’s not only ok but normal to wonder things like, “Is this baby really mine?” or “I don’t feel like her mom, I didn’t give birth.” Many moms have asked themselves these questions. Accept for yourself that your child and you have moved past that day, even if you were not unaffected by it. The feelings surrounding the birth do not have to stop you from loving your child, bonding with them and helping you both to grow.

Feel.

You have every right to feel however you want to feel. You do NOT have to dwell on feeling grateful that your child is alive or that your birth occurred the way it did. You have the right to feel questioning of the outcome and ungrateful for the way things happened.

Express.

Talk, paint, feel, write letters to the providers about your care. Write out your birth story in the way you wanted it to occur. Cry if you need to. Have a day for yourself, treating yourself well and celebrating your motherhood while allowing yourself the freedom to see the day as a multitude of different occasions that happened to different people at the same time.

Ignore.

You can ignore a child’s first birthday. The subtle way to do this is simple: Move the date. Make the party on a day that has nothing to do with the actual birth. Celebrate a half-birthday instead. You can still use a 1 candle at 1.5! You can have a small thing at home with just a cake and you and baby, celebrating together and being special in a way you were denied the first time.

All in all, treat this as if it were YOUR day. This is not simply a birthday, deserving of a Blue’s Clues cake smooshed by a happy baby. It is also the anniversary of a transition in your life that you deserve to memorialize in whatever way best suits your personal needs.

I wait every night for the inspiration to hit. Or I pick up conversations during the day to expound upon. Every one of these Cesarean Awareness Month posts so far has been based on a real woman’s story during the day or something I saw or read. Real.Tonight, there is a mother out there, giving birth. I saw her picture, arms wrapped around her partner, in love, in trust, in support. Not in an operating room, not in surgery, not in recovery. In the arms of those who love her, pouring out that beautiful moment of eternity between one contraction and the next and staring into the eyes of her star-eyed newborn who blinks against the first dawn.
She is eternal in that moment, one with everything that Creates in this moment, the knowledge of coming back from the edge in her eyes.
That connection fires the one of motherhood, fires the one of protectiveness, of instinct, of bonding. Strength and overwhelming chemical cocktails run through your body and your brain.
She is amazing.
And even if it was hard-fought, long days into long nights. Against the grain. She is a warrior.
She is not “A VBAC”, she is being born into being a mother and what she is doing is normal. The goal is not the overcoming of risk but the righting of her universe on the keel of that journey.
No matter how your cesarean happened….you deserve the right to try.
You deserve the right to believe.
Your body. Your baby. Your birth.#cesareanawarenessmonth Day 16

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